d'Huart Delfine, Steppan Martin, Seker Süheyla, Bürgin David, Boonmann Cyril, Birkhölzer Marc, Jenkel Nils, Fegert Jörg M, Schmid Marc, Schmeck Klaus
Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland.
Division of Developmental and Personality Psychology, University of Basel, Basel, Switzerland.
Front Psychiatry. 2022 Mar 24;13:840678. doi: 10.3389/fpsyt.2022.840678. eCollection 2022.
With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample.
In total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen's κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen's . Rank-order stability was assessed through Spearman's ρ.
The prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate.
The findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only "relatively" stable.
随着《国际疾病分类》第11版（ICD - 11）于2022年初实施，人格障碍（PDs）的诊断框架和流程将发生根本性变化，这表明从类别模型向维度模型的转变。尽管越来越多的证据表明人格障碍并不像之前假设的那样稳定，但人格障碍的长期稳定性仍存在重大争议。本文的目的是在一个高风险样本中研究从青少年到青年期人格障碍的类别和维度平均水平及等级顺序稳定性。
本研究共纳入115名有瑞士儿童福利机构居住史和青少年司法安置史的年轻人。在基线和10年随访时对人格障碍进行评估。在类别层面，通过从基线到随访的持续病例比例评估平均水平稳定性。通过科恩κ系数和四分相关系数评估等级顺序稳定性。在维度层面，用科恩系数测量基线和随访时人格障碍特质分数之间的变化幅度。通过斯皮尔曼ρ系数评估等级顺序稳定性。
基线时任何人格障碍的患病率为20.0%，随访时为30.4%。在基线和随访时，最常诊断的障碍是反社会型、边缘型和强迫型人格障碍。在类别层面，任何人格障碍的平均水平稳定性仅为中等，特定人格障碍的平均水平稳定性较低，除了分裂样人格障碍。同样，任何人格障碍类别的等级顺序稳定性为中等，而个体人格障碍诊断的等级顺序稳定性从低到高不等。在维度层面，除了表演型特质从基线到随访显著下降外，大多数人格障碍的分数显著增加。效应大小一般较低。维度分数的等级顺序稳定性从低到中等。
研究结果表明从青少年到成年期人格障碍及其特质的稳定性为低到中等，这支持了越来越多的证据表明人格障碍的类别诊断相当不稳定。这反过来强调了即将使用的ICD - 11，它承认人格障碍只是“相对”稳定。
